Provider Demographics
NPI:1427690338
Name:MORENO, SHARON BEATRICE
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:BEATRICE
Last Name:MORENO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 VALLEY BVLD
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91768
Mailing Address - Country:US
Mailing Address - Phone:909-865-2336
Mailing Address - Fax:909-865-1831
Practice Address - Street 1:2180 VALLEY BVLD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768
Practice Address - Country:US
Practice Address - Phone:909-865-2336
Practice Address - Fax:909-865-1831
Is Sole Proprietor?:No
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)